Rehab After ACL Surgery

acl rehab
Physical therapy is a significant part of ACL recovery.. DNY59 / Getty Images

ACL Reconstruction and Rehabilitation

Rehabilitation after surgery for an ACL tear is a lengthy process. Return to sports and activities takes months. There are many variations of ACL rehabilitation, and the information provided here is simply an overview. Specific rehabilitation must focus on each individual athlete, and you must adhere to your own protocol. It is also important to note that timelines are a guide -- progression depends on completion of one step, before advancing to the next step.

The First Days

The goals of the first days after ACL reconstruction are to minimize swelling and prevent discomfort. This can be accomplished with:

Some surgeons recommend the use of a brace after ACL surgery. This is controversial, and many surgeons choose not to use a brace at this time.

Another controversial subject is the use of a CPM, or motion machine, after surgery. Again, some surgeons will use the CPM despite a lack of evidence that it helps your recovery.

Weeks 1-2

Range of motion exercises can begin immediately after surgery. The initial focus is to regain full extension (the ability to fully straighten) of the knee. In general, flexion (ability to bend) is much easier to regain than extension.

Patients will work with physical therapists to work on gait training (walking), gentle strengthening, and aerobic work. I like to get patients on a stationary bicycle as soon as possible after surgery as this improves strength, motion and aerobic activity.

Weeks 3-6

Work is continued with physical therapy. As motion increases, emphasis is shifted to strengthening. Specifically balance and proprioceptive exercises.

Once normal motion has been achieved, some sport-specific activities can be started. Before beginning these activities, motion must be near normal and the swelling in the knee gone.

Weeks 7-12

Early sports activities can be started and patients can often begin light jogging, cycling outdoors, and pool workouts. Side-to-side, pivoting sports -- such as basketball, soccer and football -- must be avoided.

Toward the end of this phase, some athletes can begin shuttle runs, lateral shuttles and jumping rope

Months 4-7

Continued progression with sports specific activities. This phase of rehabilitation is often the most difficult, because patients may have a knee that "feels" normal, but is not ready for the stresses of some sport activities.

Emphasis of rehabilitation should be on sport simulating activities. These will include figure-of-eight drills and plyometrics, and over time will include sport drills. For example, a tennis player may start light hitting, a soccer player some controlled dribbling, etc.

Return to Sports

Deciding when to return to unrestricted sports activities depends on a number of factors:

  • Functional Progression
    The decision to return to sports must be based on each individual's progression through their therapy.
  • Graft Type
    Some surgeons may delay return to sports if the graft used to reconstruct the ACL came from a donor. Because these grafts are sterilized and frozen, there is a belief that they take longer to heal well inside the patient.
  • Surgeon Preference
    Your surgeon will guide your rehabilitation, and the ultimate decision about return to sports.

Bracing After ACL Surgery

There is also controversy about the use of braces during sports after ACL reconstruction. Studies have shown no benefit in preventing re-injury to the ACL. However, some athletes feel more comfortable in a brace, and there is no harm in wearing a sports brace.

Sources:

Beynnon BD, et al. "Rehabilitation After Anterior Cruciate Ligament Reconstruction: A Prospective, Randomized, Double-Blind Comparison of Programs Administered Over 2 Different Time Intervals" Am. J. Sports Med., Mar 2005; 33: 347 - 359.

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